温针灸治疗肩关节周围炎疗效的Meta分析

Meta Analysis of Curative Effect of Warm Needling Moxibustion for Treatment of Scapulohumeral Periarthritis

目的系统评价温针灸治疗肩关节周围炎的有效性和安全性。方法计算机检索The Cochrane Library(2020年11期)、PubMed、EMbase、CBM、CNKI、WanFang Data、VIP数据库,搜集关于温针灸治疗肩周炎的随机对照试验(RCTs),检索时限从建库至2020年9月1日。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果最终纳入26个研究,共2456例患者。Meta分析显示,(1)温针灸与普通针刺:温针灸临床总有效率高于普通针刺(RR=1.17,95%CI:1.12~1.22,P<0.00001);温针灸VAS评分优于普通针刺(MD=1.07,95%CI:0.55~1.60,P<0.0001);温针灸Constant-Murley评分低于普通针刺(MD=17.35,95%CI:7.53~27.16,P=0.0005)。(2)温针灸与电针:温针灸治疗总有效率高于电针(RR=1.15,95%CI:1.08~1.23,P<0.0001);温针灸VAS评分优于电针(MD=0.72,95%CI:0.18~1.26,P=0.010)。(3)温针灸联合推拿与推拿:温针灸联合推拿治疗总有效率优于推拿(RR=1.14,95%CI:1.04~1.25,P=0.007);温针灸联合推拿VAS评分与推拿比较,差异无统计学意义(MD=0.95,95%CI:-0.01~1.91,P=0.05);温针灸联合推拿Constant-Murley评分优于推拿(MD=0.87,95%CI:0.55~1.19,P<0.00001)。(4)温针灸与西药:温针灸治疗总有效率高于西药(RR=1.18,95%CI:1.03~1.34,P=0.01);温针灸VAS评分与西药比较,差异无统计学意义(RR=1.39,95%CI:-0.51~3.29,P=0.15);温针灸Constant-Murley评分优于西药(MD=3.01,95%CI:0.44~5.58,P=0.02)。治疗过程中均未出现晕针、滞针、烫伤等不良反应。结论相较于普通针刺、电针、推拿、西药,温针灸治疗肩周炎均能提高临床有效率;在减轻患者疼痛症状方面优于普通针刺和电针,但与推拿和西药疗效相当;在改善肩关节功能方面其临床效果优于普通针刺、推拿和西药。但受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically evaluate the effectiveness and safety of warm needle moxibustion in the treatment of scapulohumeral periarthritis.Methods Computer searched The Cochrane Library(2020,11),PubMed,EMbase,CBM,CNKI,WanFang Data,VIP database,and collected randomized controlled trials(RCTs)on warm needling moxibustion for treatment of scapulohumeral periarthritis.The search time limit is from the establishment of the database to September 1,2020.After two researchers independently screened the literature,extracted data and evaluated the risk of bias in the included studies,the RevMan 5.3 software was used for meta-analysis.Results 26 studies were finally included,with a total of 2456 patients.Meta-analysis showed that(1)Warm needling and ordinary acupuncture:The total clinical effective rate of warm needling was higher than that of ordinary acupuncture(RR=1.17,95%CI:1.12-1.22,P<0.00001);the VAS score of warm needling was better than that of ordinary acupuncture(MD=1.07,95%CI:0.55-1.60,P<0.0001);The Constant-Murley score of warm acupuncture was lower than that of ordinary acupuncture(MD=17.35,95%CI:7.53-27.16,P=0.0005).(2)Warm needling and electroacupuncture:The total effective rate of warm needling moxibustion was higher than that of electroacupuncture(RR=1.15,95%CI:1.08-1.23,P<0.0001);The VAS score of warm needling was better than that of electroacupuncture(MD=0.72,95%CI:0.18-1.26,P=0.010)(3)Warm needling combined with massage:The total effective rate of warm needling combined with massage was better than that of massage(RR=1.14,95%CI:1.04-1.25,P=0.007);There was no statistically significant difference between warm needling moxibustion combined with massage VAS score and massage(MD=0.95,95%CI:-0.01-1.91,P=0.05);The Constant-Murley score of warm acupuncture combined with massage was better than massage(MD=0.87,95%CI:0.55-1.19,P<0.00001).(4)Warm needling and western medicine:The total effective rate of warm needling and moxibustion was higher than that of Western medicine(RR=1.18,95%CI:1.03-1.34,P=0.01);There was no significant difference in the VAS score between warm needling moxibustion and western medicine(RR=1.39,95%CI:-0.51-3.29,P=0.15);The Constant-Murley score of warm acupuncture and moxibustion was better than that of western medicine(MD=3.01,95%CI:0.44-5.58,P=0.02).During the treatment,there were no adverse reactions such as needle dizziness,stuck needles,burns and so on.Conclusion Compared with ordinary acupuncture,electric acupuncture,massage,and western medicine,warm needling moxibustion can improve the clinical effectiveness in treating scapulohumeral periarthritis;it is better than ordinary acupuncture and electric acupuncture in reducing the pain symptoms of patients,but the effect is equivalent to that of massage and western medicine;Its clinical effect is better than ordinary acupuncture,massage and western medicine in improving shoulder joint function.However,limited by the number and quality of included studies,the above conclusions still need to be verified by more high-quality studies.